CROP and CORE

Q: The CROP and CORE indices are measures of weaning from which mechanical device? - Select one

A) Extracorporeal Membrane Oxygenation (ECMO)

B) Intra Aortic Balloon Pump (IABP)

C) Mechanical Ventilation

D) Pulmonary Artery Catheter (Swan-Ganz)

E) Impella cardiac assist device

Answer: C

The above question is more of an academic exercise, but its knowledge may help an intensivist to make support!

Rapid Shallow Breathing Index (RSBI) continues to supersede all other indices developed to liberate a patient from mechanical ventilation. It includes:

• Inspiratory effort quotient (IEQ) 
• The CROP index (Compliance, Rate, Oxygenation, Pressure)
• The CORE index (Compliance, Oxygenation, Respiration, Effort) 
• Weaning Index (WI) 
• Integrative weaning index (IWI) 

Details on each index are available in the references below.

ECMO (choice A) is weaned via decreasing FiO2, flow, and/or SPG (Sweep Gas Flow).

IABP (choice B) is weaned via assist per heartbeat (1:2, 1:3).

PAC (choice D) doesn't require any weaning.

Impella (choice E) is usually wean via P value (pump-support - P-9 to P-1)

#mechanical-ventilation

#pulmonary

References:

1. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991; 324:1445.

2. Nemer SN, Barbas CS, Caldeira JB, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009; 13:R152.

3. Milic-Emili J. Is weaning an art or a science? Am Rev Respir Dis 1986; 134:1107.

4. Delisle S, Francoeur M, Albert M, et al. Preliminary evaluation of a new index to predict the outcome of a spontaneous breathing trial. Respir Care 2011; 56:1500.

5. Jabour ER, Rabil DM, Truwit JD, Rochester DF. Evaluation of a new weaning index based on ventilatory endurance and the efficiency of gas exchange. Am Rev Respir Dis 1991; 144:531.